Sciarretta G, Furno A, Morrone B, Malaguti P
Department of Gastroenterology, Ospedale Maggiore, Bologna, Italy.
Am J Gastroenterol. 1994 Jul;89(7):1058-61.
Chronic diarrhea of unknown origin is often associated with bile acid malabsorption, the pathogenetic role of which is uncertain. The aim of this study was to identify morphological abnormalities in the ileal and colonic mucosa in patients with this disorder.
We performed a prospective and blinded histopathological study (between June 1991 and November 1992) of endoscopic biopsies of the distal ileum and colon of 23 patients suffering from chronic diarrhea of unknown origin. In 14, the SeHCAT (75-selena-homo-cholic acid taurine) test was abnormal owing to bile acid malabsorption; in the other nine, the diarrhea control group, the test results were normal. A detailed evaluation of surface epithelium, immune response and inflammatory changes was made.
in two patients and two controls, mild villous atrophy was observed; there was also slight inflammation of the ileal and colonic mucosa occurring with the same frequency in both groups. A slight replacement of goblet cells was more evident in the diarrhea control group.
Chronic diarrhea of unknown origin associated with bile acid malabsorption does not involve specific morphological changes of ileal or colonic mucosa, and its pathogenesis must be looked for in dysfunction of the ileum and/or colon.
不明原因的慢性腹泻常与胆汁酸吸收不良有关，但其致病作用尚不确定。本研究旨在确定患有这种疾病的患者回肠和结肠黏膜的形态学异常。
我们对23例不明原因慢性腹泻患者的回肠末端和结肠进行了前瞻性、盲法组织病理学研究（1991年6月至1992年11月）。其中14例因胆汁酸吸收不良，SeHCAT（75-硒-高胆酸牛磺酸）试验结果异常；另外9例为腹泻对照组，试验结果正常。对表面上皮、免疫反应和炎症变化进行了详细评估。
2例患者和2例对照者观察到轻度绒毛萎缩；两组回肠和结肠黏膜均有轻微炎症，且发生率相同。腹泻对照组杯状细胞的轻微替代更为明显。
与胆汁酸吸收不良相关的不明原因慢性腹泻不涉及回肠或结肠黏膜的特定形态学改变，其发病机制必须从回肠和/或结肠功能障碍中寻找。
